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Prognostic value of resting myocardial contrast echocardiography: a meta-analysis
Echo Research & Practice volume 7, pages 19–28 (2020)
Background: Resting myocardial perfusion (MP) and wall motion (WM) imaging during real-time myocardial contrast echocardiography (MCE) improves the detection of coronary artery disease (CAD). However, its prognostic role in different clinical settings (emergency department and outpatient setting) remains unclear.
Methods: A systematic search in PubMed and Embase databases, and the Cochrane library, was conducted to evaluate the role of resting MP and WM in predicting major adverse cardiac events (MACE), including death, nonfatal myocardial infarction (NFMI) and urgent revascularization in patients presenting to either outpatient clinics or emergency departments with suspected symptomatic CAD. Summary receiver operating characteristic (SROC) curves, sensitivity and specificity plots were applied to assess diagnostic performance using RevMan 5.3.
Results: Seven studies met criteria, including 3668 patients (six with follow up ranging from 2 days to 2.6 years). The Relative Risk (RR) for predicting MACE in patients with both abnormal resting MP and WM was 6.1 (95% CI, 5.1–7.2) and 14.3 (95% CI, 10.3–19.8) for death/NFMI, when compared to normal resting MP and WM patients. Having both abnormal resting MP and WM was also more predictive of MACE (RR, 1.7; 95% CI 1.5–1.9) and death/NFMI (RR, 2.2; 95% CI, 1.8–2.7) when compared to abnormal WM with normal resting MP.
Conclusion: In this meta-analysis of both ED and outpatient clinic presentations for suspected CAD, having both a resting regional MP and WM abnormality identifies the highest risk patient for adverse events.
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The authors thank Alyssa Elwood for her administrative assistance with this manuscript.
This study was partially supported by the National Natural Science Foundation of China (Grant No. 81871359), by Jiangsu Provincial Key Discipline of Medicine (ZDXKA2016003), by the Natural Science Foundation of Jiangsu Province (BK20161057), by the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX18_1478) and the China Scholarship Council (201808320318). This was also supported by the Theodore F Hubbard Foundation at the University of Nebraska Medical Center.
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Qian, L., Xie, F., Xu, D. et al. Prognostic value of resting myocardial contrast echocardiography: a meta-analysis. Echo Res Pract 7, 19–28 (2020). https://doi.org/10.1530/ERP-20-0023
- myocardial contrast echocardiography
- coronary artery disease